Editor's
note: Chelsey Baldwin of Little
River is a second-year medical
student. This column follows the
journey of her class in becoming
doctors.

"Are you going
to let her starve to death?" our
patient's adult son questions us
during a scenario constructed to
test our ability to apply ethical
theory to clinical settings. The
harshness of the question induces
a transient episode of blank
stares and ruffled brows in our
group classroom.

We progress to
muddling over definitions of
futility, best interests, positive
and negative rights. We eventually
decide that allowing the patient
to die because of a lack of
nutritional supplementation was an
ethical course of action guided by
the principle of medical futility.
In this scenario, we discuss an
82-year-old woman with end stage
dementia who is no longer able to
take nutrition orally. Given the
patient's grim prognosis, we
rationalized that there was no
medical benefit to placing a
percutaneous endoscopic
gastrostomy (PEG) feeding tube,
which would merely be a medical
intervention applied to prolong
the inevitable without the hope of
improving the patient's quality of
life or chances of survival.

This decision
is supported by the literature,
yet despite this support net, how
would we possibly convey this
morbid conclusion with mortal
implications to our patient's son?
Does our mastery of definitions
and pockets full of literary
support translate into promises of
genuine intentions for a grieving
family member?

I had often
wondered how a physician might
come to be competent in such
ethical matters and not
surprisingly have come to discover
that we take a course on this,
too. As a part of the second year
curriculum, we have been
introduced to medical ethics, a
course which will continue for the
remainder of medical school. The
course aims to increase the
medical student's competency, not
only regarding our moral duties to
our patients, but also the legal
restraints that may alter the way
we practice medicine. In an
attempt to obtain these goals, my
teammates and I debate the correct
course of action in practice
scenarios.

As we move
toward approaching the family with
our medical conclusions, we aim to
not only give them advice. We also
want to incorporate family and
those who feel they have a close
relationship with the patient.
Integration of the family fits
with the latest medical theories
of patient- and family-centered
care. According to the Institute
for Patient And Family-Centered
Care, "Patient and family-centered
practitioners recognize the vital
role that families play in
ensuring the health and well-being
of infants, children, adolescents,
and family members of all ages.
They acknowledge that emotional,
social, and developmental support
are integral components of health
care."

Our discussion
leader asks the group, "how will
you proceed when an agreement
cannot be reached despite your
best attempts at eliciting the
family's understanding of the
situation and presenting them with
needed information?"

The answer is
seemingly clear, since the law has
set forth the order by which
surrogates will resume the power
of making decisions. However, this
too can be muddied by our
perception of the surrogate's
intentions. If the surrogate is
not acting in the best interest of
the patient, we are obligated to
intervene. This creates yet
another complicating layer as the
group discusses the possibility of
causing the patient more harm by
informing them of the suspicious
intentions on the part of the
surrogate.

Our scenario is
further complicated by the
patient's depleted financial
support. We are then asked how
this should shape our decisions
about treatment. Our sole
philosophy major spouts off
theories pertaining to the
allocation of resources for the
greater good.

Even I, as a
biology major, am not foreign to
these theories of utilitarianism;
however, the thought of them being
applied at the bedside is
cringe-worthy. These concepts
demanding consciousness of the
masses are overwhelming when
staring into the face of a
patient. No, this is not our job,
and we must grant ourselves leeway
from such social burdens and be a
doctor to our patient.

By the end of
our student discussions, we have
talked in circles and come to few,
if any, solid conclusions. It is
the journey through this process
that our preceptor says is the
most important. Dr. Joseph John,
an internist at the veteran's
hospital and clinical professor of
medicine and microbiology, is a
physician well-seasoned in our
ethical dilemmas. He assures us
that the process has produced
physicians before his eyes and
guarantees that we too will follow
in their footsteps.

While our minds
swim in the sea of our future
responsibilities to make the
morally correct decisions, for now
it is a relief to know the
fallback answer remains: Answer
Choice C. Consult the Ethics
Board.

Friday,
March 30, 2012

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